Kimberly Montes-Rojas
Indio,CA
Summary
Certified Professional Coder (CPC) specializing in hospital-based professional billing with a focus on outpatient coding for wound care, rheumatology, and radiology. Demonstrates proficiency in ICD-10-CM, CPT, HCPCS, OPPS, and NCCI edits, contributing to effective claim management. Experienced in resolving split-billing claims, correcting charges, and reviewing documentation within Epic Resolute (PB). Educational background includes a Bachelor of Science in Biological Sciences, enhancing coding precision and medical decision-making analysis.
Overview
21
21
years of professional experience
Work History
Coder I
Eisenhower Medical Center
04.2025 - Current
- Assign ICD-10-CM, CPT, and HCPCS codes for multi-specialty professional services including outpatient visits, inpatient E/M, radiology (mammography, DEXA, ultrasounds), wound care management, podiatry procedures, rheumatology encounters, and SNF admissions.
- Perform E/M leveling for outpatient and inpatient professional services ensuring documentation supports medical necessity and accurate code selection to the highest degree of specificity
- Analyze provider documentation for compliance with CMS guidelines, OPPS reimbursement methodology, NCCI edits, LCD coverage criteria, and payer-specific requirements.
- Resolve claim edits, charge corrections, and work queue issues in Epic Resolute (PB) to support compliant reimbursement and reduce rework.
- Investigate denied claims, prepare supporting documentation, and assist with appeals to facilitate reimbursement recovery.
- Collaborate with billing leadership, revenue cycle management, and clinical providers to address documentation challenges, optimize workflows, and improve coding accuracy.
- Provide coding clarification and documentation guidance to enhance compliance and reduce denial risk.
Release of Information Technician
Eisenhower Medical Center
08.2024 - 04.2025
- Reviewed clinical documentation, applying E/M and coding guidelines for payer encounters.
- Resolved claim edits and charge discrepancies to ensure accurate reimbursement.
- Assisted with prior and retro authorization requests for drugs and procedures.
- Verified insurance eligibility and payer policy coverage requirements.
- Collaborated with billing staff to address documentation issues and improve revenue cycle efficiency.
Medical Assistant
Pennyroyal Healthcare Services
01.2019 - 01.2021
- Assisted physicians in conducting diagnostic tests and procedures.
- Applied ICD-10-CM and CPT coding conventions for ordered services.
- Verified insurance benefits and eligibility to ensure accurate billing.
- Supported documentation accuracy and maintained compliance with billing regulations.
Medical Assistant
Elite Primary Care
Clarksville, TN
08.2017 - 03.2018
- Collected medical histories and supported documentation for providers.
- Assisted with ICD-10 and CPT code utilization for diagnostic services.
- Coordinated referrals and verified insurance information to ensure accurate processing.
Medical Scribe
Gateway Medical Assosciate
02.2016 - 07.2017
- Documented patient encounters in real time during examinations.
- Recorded diagnosis, treatment plans, and prescriptions to maintain accurate medical records.
Medical Assistant/Surgical Technician
G.I. Specialist of Clarksville
Clarksville, TN
01.2014 - 01.2016
- Supported endoscopic procedures and outpatient surgical care to enhance operational efficiency.
- Managed specimen collection and processing for pathology to ensure accurate diagnostics.
- Coordinated referrals, verified insurance, and followed up on claims to reduce delays.
- Resolved coverage issues and denials through effective communication with payers.
- Acquired foundational knowledge of medical terminology and coding systems for improved accuracy.
Medical Assistant
Dr. Cynthia Taylor
01.2009 - 12.2009
- Assisted with minor procedures and performed phlebotomy tasks.
- Supported billing and coding processes to improve claim accuracy.
- Assisted patients with intake and registration processes at community health clinics.
- Managed appointment scheduling and coordinated follow-up visits for diverse patient populations.
- Supported medical staff during examinations and procedures by preparing necessary equipment.
Lab Assistant
St. Francis Hospital
01.2007 - 12.2007
- Acquired and analyzed laboratory specimens in accordance with clinical protocols.
Internship to Hire| Medical Assistant
Veterans Hospital
01.2005 - 12.2007
- Assisted providers in delivering patient care and completing clinical documentation.
- Assisted healthcare providers with patient examinations and procedures.
Education
Certification - Certified Professional Coder
AAPC
Online07-2025
Bachelor of Science - Biological Science
Arizona State University
Tempe12-2021
Medical Assistant Certification -
Bryman College
Tacoma, WA12-2015
Skills
- ICD-10-CM, CPT, HCPCS Coding
- Outpatient & Inpatient E/M Leveling
- LCD Review & Medical Necessity Validation
- Claim Edit Resolution
- Denial Management & Appeals
- Prior & Retro Authorization
- OPPS & NCCI Edit Analysis
- Split-Billing Documentation Review
- Professional Billing Workflows
- Revenue Cycle Optimization
- Epic Resolve (PB) Workqueues
- Compliance & Documentation Review
Languages
- Spanish
- English
Jackie Lee Houston Shining Star Nominee - April 2025
Recognized by Supervisor for Performance Excellence
Timeline
Coder I
Eisenhower Medical Center
04.2025 - Current
Release of Information Technician
Eisenhower Medical Center
08.2024 - 04.2025
Medical Assistant
Pennyroyal Healthcare Services
01.2019 - 01.2021
Medical Assistant
Elite Primary Care
08.2017 - 03.2018
Medical Scribe
Gateway Medical Assosciate
02.2016 - 07.2017
Medical Assistant/Surgical Technician
G.I. Specialist of Clarksville
01.2014 - 01.2016
Medical Assistant
Dr. Cynthia Taylor
01.2009 - 12.2009
Lab Assistant
St. Francis Hospital
01.2007 - 12.2007
Internship to Hire| Medical Assistant
Veterans Hospital
01.2005 - 12.2007
Certification - Certified Professional Coder
AAPC
Bachelor of Science - Biological Science
Arizona State University
Medical Assistant Certification -
Bryman College